Method and system for ensuring and tracking hand hygiene compliance

ABSTRACT

A system includes a hand hygiene dispenser comprising a housing comprising an input for detecting hand sanitizing events when hand sanitizer is dispensed from a container, and a memory for storing the hand sanitizing events, a computing device configured to receive data from the hand hygiene dispenser regarding when one or more hand sanitizing events have occurred, and a calculation module configured to detect whether a predetermined amount of hand sanitizing solution is used, wherein detecting whether the predetermined amount of hand sanitizing solution is used including detecting a number of dispenser activations, measuring, by a sensor in communication with the calculation module, an amount of hand sanitizing solution within the container, and comparing the number of dispenser activations with the measured amount of hand sanitizing solution in the container.

This application is a continuation of U.S. application Ser. No.14/604,207, filed on Jan. 23, 2015, which is a continuation-in-part ofU.S. application Ser. No. 14/029,746, filed on Sep. 17, 2013, whichclaims the benefit of and priority to U.S. Provisional Application No.61/702,013, filed on Sep. 17, 2012. All of the above applications arehereby incorporated by reference herein in their entireties.

TECHNICAL FIELD

The disclosure herein relates generally to a system and method forencouraging hand washing and for monitoring and determining compliancewith hand washing requirements in healthcare settings.

BACKGROUND

Every year tens of thousands of people will die from infections theyacquire while admitted as patient in a hospital. These hospital-acquiredinfections or nosocomial infections are unrelated to their initialhospital admission.

According to the CDC (Center for Disease Control & Prevention) in theUnited States, more than 50% of all nosocomial infections aretransmitted due to improper hand washing by health care workers beforeand after each patient contact.

Health care workers have indicated that hand washing compliance isdifficult because there is “not enough time and not enough convenientlylocated hand washing stations to wash hands as often as required.”Compliance with hand washing guidelines is becoming worse and moredifficult. Because of staff reductions, hospitals require healthcareworkers to take care of an increasing number of patients during workshifts. Additionally, hospitals are seeing high transmission rates ofantibiotic resistant bacteria and viruses, which requires stricteradherence to the CDC hand washing guidelines. Hospitals need productsand services that boost and encourage hand washing, and methods toensure and measure compliance.

BRIEF SUMMARY

The following presents a simplified summary of the disclosure in orderto provide a basic understanding of some aspects. It is not intended toidentify key or critical elements of the disclosure or to delineate thescope of the disclosure. The following summary merely presents someconcepts of the disclosure in a simplified form as a prelude to the moredetailed description provided below.

In one example, a computer-implemented method may include tracking thedispensing of a plurality hand hygiene dispensers having hand sanitizerand each hand hygiene dispenser being associated with an individualuser. The method may include one or more of the following steps:determining by a processor dispensing rates of the plurality of handhygiene dispensers for a plurality of predetermined time periods,identifying each of the plurality of the hand hygiene dispensers with anindividual user, determining by a processor a predetermined number ofhighest dispensing rates out of the plurality of predetermined timeperiods and calculating an average dispensing rate based on thepredetermined number of highest dispensing rates, displaying thedispensing rates of the plurality of hand hygiene dispensers, andnotifying an individual user regarding the individual user'sperformance.

In another example, a system may include a plurality of hand hygienedispensers, where each hand hygiene dispenser can include a housingconfigured to receive a container adapted to store hand sanitizer. Thehousing may include an input for detecting hand sanitizing events whenhand sanitizer is dispensed from the container, and the input may belocated within the housing. The housing may also include a memory forstoring hand sanitizing events, and an accelerometer for recordingmotion information in memory and for determining whether the handhygiene dispenser is in use. Each hand hygiene dispenser may beconfigured to communicate to a network via a low energy transmissionprotocol.

These and other aspects are discussed in greater detail throughout thisdisclosure, including the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure is illustrated by way of example and not limitedin the accompanying FIGS. in which like reference numerals indicatesimilar elements and in which:

FIG. 1 shows an illustrative environment in which various aspects of thedisclosure may be implemented.

FIG. 2 is an illustrative diagram of workstations and servers that maybe used to implement the processes and functions of certain aspects ofthe disclosure herein.

FIG. 3 depicts a front, left perspective view of an exemplary embodimentof a personal hand sanitizer dispenser.

FIG. 3A depicts a perspective view of another exemplary embodiment of apersonal hand sanitizer dispenser.

FIG. 3B depicts another perspective view of the exemplary embodiment inaccordance with FIG. 3A.

FIG. 3C depicts another perspective view of the exemplary embodiment inaccordance with FIG. 3A.

FIG. 3D depicts another perspective view of the exemplary embodiment inaccordance with FIG. 3A.

FIGS. 4-8 depict exemplary displays for displaying hand hygiene andrelated data.

FIGS. 9-12B depict exemplary notifications for encouraging proper handhygiene.

FIG. 13A shows a front perspective view of another example hand hygienedispenser.

FIG. 13B shows a side perspective view of the example hand hygienedispenser of FIG. 13A.

FIG. 13C shows a rear perspective view of the hand hygiene dispenser ofFIG. 13A.

FIG. 13D shows a bottom perspective view of the hand hygiene dispenserFIG. 13A.

FIG. 13E shows an alternate configuration of the hand hygiene dispenserof FIG. 13A.

FIG. 13F shows a rear view of an alternate configuration of the handhygiene dispenser of FIG. 13A.

FIG. 13G shows another rear perspective view of an alternateconfiguration of the hand hygiene dispenser of FIG. 13A.

FIGS. 14A and 14B depict an example printed circuit board for a handhygiene dispenser.

FIG. 15A shows a front perspective view of another example hand hygienedispenser.

FIG. 15B shows another front perspective view of the example handhygiene of FIG. 15A in another configuration.

FIG. 15C shows a rear perspective view of the example hand hygienedispenser of FIG. 15A.

FIG. 15D shows a rear perspective view of the hand hygiene dispenser ofFIG. 15A in another configuration.

FIG. 16 depicts an example certificate of clinical excellence.

FIG. 17 depicts an example of a performance coach decision matrix.

DETAILED DESCRIPTION

In the following description of various example structures in accordancewith this disclosure, reference is made to the accompanying drawings,which form a part hereof, and in which are shown by way of illustrationof various structures in accordance with the disclosure. Additionally,it is to be understood that other specific arrangements of parts andstructures may be utilized, and structural and functional modificationsmay be made without departing from the scope of the disclosure. Also,while the terms “top” and “bottom” and the like may be used in thisspecification to describe various example features and elements of thedisclosure, these terms are used herein as a matter of convenience,e.g., based on the example orientations shown in the figures and/or theorientations in typical use. Nothing in this specification should beconstrued as requiring a specific three dimensional or spatialorientation of structures in order to fall within the scope of thisdisclosure. In the disclosure, various headings are used only forconvenience purposes. These headings are not intended in any way limitthe scope of the disclosure. Before discussing the aspects of thedisclosure in greater detail, however, several examples of a networkarchitecture and a data processing device that may be used inimplementing various aspects of the disclosure will first be discussed.

I. Detailed Description of Example Network Architecture and DataProcessing Device that May be Used to Example Methods for Ensuring HandHygiene Compliance

Computing System

FIG. 1 generally depicts a computing system environment 100 forimplementing the hand hygiene monitoring methods described herein. Thehand hygiene monitoring system can comprise a plurality of hand hygienedispensers 208, a network, a computing device 101, branch computingdevices 141 and 151, and one or more mobile devices 161. Each of thedevices can be linked to the network by any known means. The handhygiene dispensers 208 can be worn by health care workers or can beprovided throughout a particular facility by any known means, such as astand-alone units or wall-mounted units.

The computing system environment 100 is only one example of a suitablecomputing environment and is not intended to suggest any limitation asto the scope of use or functionality of the disclosure. The computingsystem environment 100 should not be interpreted as having anydependency or requirement relating to any one or combination ofcomponents shown in the illustrative computing system environment 100.

The exemplary embodiments disclosed herein are operational with numerousother general purpose or special purpose computing system environmentsor configurations. Examples of well known computing systems,environments, and/or configurations that may be suitable for use withthe exemplary embodiments include, but are not limited to, personalcomputers, server computers, hand-held or laptop devices, multiprocessorsystems, microprocessor-based systems, set top boxes, programmableconsumer electronics, network PCs, minicomputers, mainframe computers,distributed computing environments that include any of the above systemsor devices, and the like.

With reference to FIG. 1, the computing system environment 100 mayinclude a computing device 101 wherein the processes discussed hereinmay be implemented. The computing device 101 may have a processor 103for controlling overall operation of the computing device 101 and itsassociated components, including RAM 105, ROM 107, communications module109, and memory 115. Computing device 101 typically includes a varietyof computer readable media. Computer readable media may be any availablemedia that may be accessed by computing device 101 and include bothvolatile and nonvolatile media, removable and non-removable media. Byway of example, and not limitation, computer readable media may comprisea combination of computer storage media and communication media.

Computer storage media include volatile and nonvolatile, removable andnon-removable media implemented in any method or technology for storageof information such as computer readable instructions, data structures,program modules or other data. Computer storage media includes, but isnot limited to, random access memory (RAM), read only memory (ROM),electronically erasable programmable read only memory (EEPROM), flashmemory or other memory technology, CD-ROM, digital versatile disks (DVD)or other optical disk storage, magnetic cassettes, magnetic tape,magnetic disk storage or other magnetic storage devices, or any othermedium that can be used to store the desired information and that can beaccessed by computing device 101.

Communication media typically embodies computer readable instructions,data structures, program modules or other data in a modulated datasignal such as a carrier wave or other transport mechanism and includesany information delivery media. A modulated data signal is a signal thathas one or more of its characteristics set or changed in such a manneras to encode information in the signal. By way of example, and notlimitation, communication media includes wired media such as a wirednetwork or direct-wired connection, and wireless media such as acoustic,RF, infrared and other wireless media.

Although not shown, RAM 105 may include one or more applicationsrepresenting the application data stored in RAM memory 105 while thecomputing device is on and corresponding software applications (e.g.,software tasks), are running on the computing device 101.

Communications module 109 may include a microphone, keypad, touchscreen, bar code scanners, and/or stylus through which a user ofcomputing device 101 may provide input, and may also include one or moreof a speaker for providing audio output and a video display device forproviding textual, audiovisual and/or graphical output.

Software may be stored within memory 115 and/or storage to provideinstructions to processor 103 for enabling computing device 101 toperform various functions. For example, memory 115 may store softwareused by the computing device 101, such as an operating system 117,application programs 119, and an associated database 121. Alternatively,some or all of the computer executable instructions for computing device101 may be embodied in hardware or firmware (not shown). Database 121may provide centralized storage.

Computing device 101 may operate in a networked environment supportingconnections to one or more remote computing devices, such as branchterminals 141 and 151. The branch computing devices 141 and 151 may bepersonal computing devices or servers that include many or all of theelements described above relative to the computing device 101. Branchcomputing device 161 may be a mobile device communicating over wirelesscarrier channel 171 or through a wireless LAN, WAN or a WiFi network.

The network connections depicted in FIG. 1 include a local area network(LAN) 125 and a wide area network (WAN) 129, but may also include othernetworks. When used in a LAN networking environment, computing device101 is connected to the LAN 125 through a network interface or adapterin the communications module 109. When used in a WAN networkingenvironment, the computing device 101 may include a modem in thecommunications module 109 or other means for establishing communicationsover the WAN 129, such as the Internet 131. It will be appreciated thatthe network connections shown are illustrative and other means ofestablishing a communications link between the computing devices may beused. The existence of any of various well-known protocols such asTCP/IP, Ethernet, FTP, HTTP and the like is presumed, and the system canbe operated in a client-server configuration to permit a user toretrieve web pages from a web-based server. Any of various conventionalweb browsers can be used to display and manipulate data on web pages.

Additionally, one or more application programs 119 used by the computingdevice 101, according to an illustrative embodiment, may includecomputer executable instructions for invoking user functionality relatedto communication including, for example, email, short message service(SMS), and voice input and speech recognition applications.

Exemplary embodiments discussed herein may include forms ofcomputer-readable media. Computer-readable media include any availablemedia that can be accessed by a computing device 101. Computer-readablemedia may comprise storage media and communication media. Storage mediainclude volatile and nonvolatile, removable and non-removable mediaimplemented in any method or technology for storage of information suchas computer-readable instructions, object code, data structures, programmodules, or other data. Communication media include any informationdelivery media and typically embody data in a modulated data signal suchas a carrier wave or other transport mechanism.

Although not required, one of ordinary skill in the art will appreciatethat various aspects described herein may be embodied as a method, adata processing system, or as a computer-readable medium storingcomputer-executable instructions. For example, a computer-readablemedium storing instructions to cause a processor to perform steps of amethod in accordance with aspects of the disclosure is contemplated. Forexample, aspects of the method steps disclosed herein may be executed ona processor on a computing device 101. Such a processor may executecomputer-executable instructions stored on a computer-readable medium.

Referring to FIG. 2, an illustrative system 200 for implementingexemplary methods disclosed herein is shown. As illustrated, system 200may include one or more workstations 201, mobile devices 206, and handhygiene dispensers 208. Local or remote workstations 201, mobile devices206, and hand hygiene dispensers 208 are connected by one ofcommunications links 202 to computer network 203 that is linked viacommunications links 205 to server 204. In system 200, server 204 may beany suitable server, processor, computer, or data processing device,cloud, or combination of the same. Server 204 may be used to processhand hygiene data received from the dispensers 208.

Computer network 203 may be any suitable computer network including theInternet, an intranet, a wide-area network (WAN), a local-area network(LAN), a wireless network, a digital subscriber line (DSL) network, aframe relay network, an asynchronous transfer mode (ATM) network, avirtual private network (VPN), or any combination of any of the same.Communications links 202 and 205 may be any communications linkssuitable for communicating between workstations 201, mobile devices 206,and server 204, such as network links, dial-up links, wireless links,hard-wired links, etc. For example, the communications links 202 and 205can be twisted pair wires, coaxial cable, fiber optics, radio waves(fixed or plug-in radio options), or other communication media. Thecommunications links 202 and 205 can be made via the internet, Ethernet,Bluetooth, Wi-Fi, cell modems, or infrared. In one specific example, thecommunications links 202 and 205 can be made using a reduced powerconsumption type of communication or low-power radio signals, e.g.,Bluetooth Low Energy (also referred to as “Bluetooth LE,” “BluetoothSmart,” or “BLE”), Zigbee, and ISM. In one example, the ISM can be NFC.Nevertheless, any other known method of wireless transmission iscontemplated for forming the above connections, including other highlyefficient proprietary and custom protocols.

As understood by those skilled in the art, the system and steps thatfollow in the FIGS. may be implemented by one or more of the componentsin FIGS. 1 and 2 and/or other components, including other computingdevices.

II. Detailed Description of Example Hand Hygiene Dispensers and ExampleMethods for Ensuring Hand Hygiene Compliance

A computing system, which can be a calculation module, is configured toaccept data from a plurality of personally worn devices attached touser's clothing or attached to a lanyard worn by the user to dispensehand washing agents. A series of algorithms in the computing system orthe calculation module use the data to calculate and display variouspieces of information relating to the user's hand hygiene behavior. Thisinformation may include: the user's hand hygiene rate of use, complianceto a set goal, reminders and remediation of lack of goal achievement,user location, total hand hygiene events, time in the clinicalenvironment, various types of reports based on this information, etc.The information may also be used for reporting to management andregulatory/accreditation agencies. The computing system may also provideeducational materials, facilitate communication between users and systemadministrators, and automated messaging to users, management and otherinterested parties. The computing system or the calculation module canreside in any location on the network can be implemented on anycomputing device of hand hygiene dispenser within the network. It isalso contemplated that the computing system or calculation module can bea set of instructions stored on a computer usable medium and can be partof a computer readable program code embodied on the computer readablemedium, such that the computer readable program code can be adapted tobe executed by a processor to implement the methods and calculationspertaining to tracking hand hygiene performance.

In general, the hand hygiene monitoring system uses a set of algorithmsin a computer readable medium that are executable by a processor toprovide for automated hand hygiene compliance management and trackingand assists in achieving accountability to the user. The hand hygienemonitoring system can be implemented to help users be self-accountableto agreed-upon hand hygiene goals by providing direct and anonymousfeedback to the user. However, in some exemplary embodiments, if theuser continues to have poor hand hygiene performance then he/she maylose anonymity and must be accountable to a peer and/or manager. Thehand hygiene monitoring system compares the user's average rate to apredetermined goal rate. If the average rate is less than the goal rate,the user receives notice, and the notice escalates with continuedperformance below the goal.

In some exemplary embodiments, each user is assigned a user ID number oralphanumeric ID sequence that is communicated to the user and by whichusers reference their anonymous hand hygiene data. In one example, whennew users receive their dispensers, each dispenser can be associatedwith the particular user by the dispenser/user ID. For example, thedispenser could be provided with a barcode that can be scanned or thesystem can randomly or sequentially assign the dispenser/user ID oncethe user is provided with a dispenser.

In one example, the dispenser/user ID is only provided to the user. Thiscan help the user's feel that management is not actively monitoring theuser's hand hygiene habits and may help encourage effectiveparticipation in hand hygiene by users. For example, when new users areadded, the software interface does not display the user ID or it may berepresented as a series of asterisks. The user ID can be communicated tousers by private email, text messaging, posted letter, or on peel-andreveal labels applied to their personal dispensers. In one example, tokeep the hand hygiene data anonymous, there may be no way for managementto list or review the user IDs associated with names. Users can findtheir hand hygiene data on computer monitors and reports by referencingtheir user ID or receive their hand hygiene data by email, textmessaging, and the like. User IDs may be a minimum number of digits inorder to be more easily remembered by users.

The number of discrete IDs can be maximized by segregating user groupsby care unit and hospital or other organizational units. These multipleuser groupings can be represented in the database as codes combined withthe user ID the user sees. For example, there may be a hospital code,e.g., GENH, a care unit code, e.g., SICU, and a user ID, e.g., 1234 tobe internally combined in the database, e.g., GENH_SICU_1234. Thismethod accommodates a virtually unlimited number of user IDs as userswill not physically see a duplicate user ID at other facilities orlocations.

Personal Hand Hygiene Dispensers

As depicted in FIG. 3, the personal hand hygiene dispensers 208 maycomprise a reservoir 212 for hand sanitizer, an actuator 210 fordispensing hand sanitizer, an attachment mechanism (not shown) forattaching the dispenser 208 to the health care worker's clothing orlanyard, a RF, IR, or other known type of wireless transmitter, memorycircuit, and a light indicator 214 for the actuator 210. Additionally,the hand hygiene dispensers 208 can include a processor, RAM, ROM, and amemory for storage to provide instructions to the processor for enablingthe hand hygiene dispensers 208 to perform various functions. In yetanother example, the dispenser 208 may also include a display screen fordisplaying performance data, such as the user's average dispensing rate,to the user.

The reservoir 212 can be a refillable reservoir or can be implemented asa replaceable cartridge. The contents of the cartridge are squeezedthrough an opening in the back of the dispenser (not shown) to dispensehand sanitizer while the actuator 210 is pressed simultaneously to senda signal via a transmitter to indicate to the server that a hand hygieneevent has occurred. It is contemplated that the actuator can bothdispense the hand sanitizer from the dispenser 208 and activate thetransmitter to send the signal indicating that a hand hygiene event hasoccurred. In one embodiment, the actuator 210 triggers a switch attachedto or on the memory circuit in the dispenser that records the event tobe downloaded to a computer, for example, when the actuator is synced.The actuation may be associated with a time interval that is stored inthe memory circuit and represents the time and date of each activation.

In another example, the dispensing action can be stored on the dispensercomputer for downloading at a later time. This minimizes the use ofpower by the personal dispenser 208. In one example, the transmitter canbe programmed to look for a signal periodically (e.g. once an hour) anddownload dispensing or other performance data at that time. In anotherexemplary embodiment, the plurality of personal dispensers 208 mayindividually be placed in a designated area at the end of the user workday, and the data can be transmitted (e.g. via WiFi) to the server.Other known techniques for transferring the data from the dispensers 208to the server are also contemplated.

The personal dispenser 208 may be outfitted with a sensor (not shown) todetect the amount of dispensing fluid located in the reservoir 212, andthe sensor or an additional sensor can also be configured to detect whenthe reservoir 212 of the hand sanitizer is changed by the user orotherwise in the personal dispenser 208. The sensor or additionalsensors can also be configured to detect whether the user is using anappropriate amount of hand sanitizing solution.

In another embodiment not shown, the personal dispenser 208 can also beoutfitted with firmware programming and an electronic display to displaythe user's immediate hand hygiene rate or number of uses within a giventime period. The time period for the rate or number of uses can be basedon shift or work periods calculated by the firmware (motion detectionsince a period of inactivity) or downloaded from a server. This displaycan be provided to help the user stay on track with reaching a goal handhygiene rate.

The user can carry the dispenser by attaching the dispenser 208 tohis/her clothing via any known attachment mechanism. One example of anattachment mechanism 216 is provided in FIGS. 3A-3D. The attachmentmechanism 216 can help attach the dispenser 208 to the user's clothing.The attachment mechanism 216 can attach to the user's clothing by use ofmagnets. Two magnets can be located on the first side 216 a of theattachment mechanism 216 for securing the attachment mechanism 216 tothe user's clothing. In particular, a corresponding bar (not shown) withmagnets can be placed on the opposite side of the user's clothing, andthe bar can be aligned with the first side 216 a of the attachmentmechanism 216 to magnetically secure the first side 216 a of theattachment mechanism 216 to the user's clothing.

On the second side 216 b, the attachment mechanism 216 can be formedwith two slots 218 a, 218 b formed from a protruding component 226 ofthe attachment mechanism 216. The slots 218 a, 218 b can be configuredto receive a circular disk-shaped member 220 therein to align thedisk-shaped member 220 with a corresponding circular recess 222 alsoformed by the protruding component 226. The disk-shaped member 220 hasan oblong-shaped cam 224. The cam 224 aids in securing the attachmentmechanism 216 to the dispenser 208 by locking the disk-shaped member 220between the recess 222 and the protruding component 226. The disk-shapedmember 220 is also provided with a projection 228, which is configuredto snap into a corresponding slot 232 on the dispenser housing 230. Theprojection 228 can be formed by two male flexible elements 228 a, 228 bthat are configured to securely fit within the corresponding slot 232via a snap-fit connection.

To attach the dispenser housing 230 to the attachment mechanism 216, theprojection 228 is aligned with the slot 232. This allows the projection228 two flexible elements 228 a, 228 b to snap into a locking engagementwith the slot 232 on the dispenser housing 230.

The disk-shaped member 220 and cam 224 can then be aligned with the twoslots 218 a, 218 b formed in the protruding component 226 of theattachment mechanism 216 until the disk-shaped member 220 is held withinthe corresponding circular recess 222. Once the disk-shaped member 220is held within the corresponding circular recess 222, the user can thentwist the disk-shaped member 220 until the dispenser 208 is upright suchthat the cam 224 holds the disk-shaped member in the recess 222 bylocking the disk-shaped member 220 between the recess 222 and theprotruding component 226.

The user can then attach the dispenser 208 to his/her clothing byplacing the bar with magnets on the inside of his/her clothing and thensecuring the first side 216 a of the attachment mechanism 216 to theoutside of his/her clothing. In this way, the bar is aligned with thefirst side 216 a of the attachment mechanism 216 to magnetically securethe first side 216 a of the attachment mechanism 216 to the user'sclothing.

The personal dispenser can also be provided with a switch and dispensingmechanism, for example, a pump or pressurized container that woulddispense a predetermined amount of hand sanitizer solution each time theuser activates the switch in order to ensure that an appropriate amountof hand sanitizer is used. In this way, the user will rub an appropriateamount of hand sanitizer on his/her hands. This also makes it difficultfor the user to avoid using the requisite amount, and ultimately thiscould encourage use and could discourage cheating or users from usingtoo small of amounts of hand sanitizer.

The exemplary embodiments discussed above describe a personal dispenserthat the user can wear on his/her clothing, carried by the user in theuser's clothing or worn by the user on a lanyard, etc. A personally worndispenser can always be available, especially around the patient when itis needed. However, it is also contemplated that the dispenser can bestationary in a given treatment area and can be, for example, wallmounted or mounted on a stand.

Methods of Operation

The dispensers 208 can be provided to a plurality of users for useduring the users' work shifts. Each individual dispenser 208 is uniquelyidentified with a particular user such that the user's dispensing ratecan be tracked and logged. The dispenser electronics are uniquelyidentifiable by a “tag ID” which can be stored in the dispenser's ROM.This ID is a code that is unique to a specific dispenser and can betransmitted along with other data when the actuator 210 is activated.This ID can be an RFID. The tag ID is then associated with a user codeand can be assigned to a user in the dispenser configuration software.The user code can be assigned such that only the user knows theirparticular user code so that the dispenser tracking can remain anonymousas discussed above. The user code is used to identify any datacalculated for an associated user and displayed by the system.

During use, the user presses the actuator 210 and squeezes thecartridge/reservoir to dispense hand sanitizer from the reservoir 212onto his/her hands. The actuator 210 also triggers the transmitterwithin the dispenser housing and the light indicator 214 or otheraudible or tactile mechanism to notify the user that a signal has beentransmitted. The transmitter communicates with the network to recordthat a hand hygiene event has occurred by sending a unique identifieralong with a time and date stamp through the network to a datacollector.

The transmitter can communicate wirelessly over the network, e.g.,Wi-Fi, to a central server. Additionally the transmitter can communicatewith one or more data collectors that are connected via wire orwirelessly to the network. The transmitter can indicate to the serverthe dispenser's unique ID, the time the dispenser is within a givenarea, the time of the dispensing action, the location of the dispenser,and the particular dispenser that is used. The time of the activationcould also be established by the server based on the real-time receiptof a communication from the dispenser triggered by the activation of thedispenser. This can then be stored in a server located in a healthcarefacility or can be sent to an outside server or cloud. The data is thenanalyzed as discussed herein to determine whether the user is meetinghand hygiene rate goals.

In one exemplary embodiment, during use, the personal dispenser isconfigured to sense the amount dispensing fluid located in the reservoir212 and can notify the user when the dispenser 208 needs to be refilled.The dispenser 208 can also notify the network via the transmitter whenthe reservoir 212 of hand sanitizer has been changed for tracking andservicing purposes. The dispenser 208 can also track whether the user isusing an appropriate amount of hand sanitizing solution and notify thenetwork if the appropriate amount of hand sanitizing solution is notused. The dispensing amount can be monitored by recording the number ofdispenser activations and comparing the number of activations with theamount of hand sanitizer in the reservoir to determine if an appropriateamount of sanitizer is being used. Additionally, another sensor can beprovided to detect battery life of the dispenser, which can be displayedto the user on the dispenser or sent to the user via text, email,dispenser display, kiosk, or any other known method of communicatingwith the user.

In alternative exemplary embodiments, during a predetermined time periodor shift of the user, an electronic screen displays the user's immediatereal-time and/or historical hand hygiene rate, which can be viewed bythe user at any time during the shift to assist the user with staying ontrack to reach a goal rate. The personal dispenser electronics can havecapabilities to sense activation of the actuator then calculate anddisplay the rate on the dispenser. The dispensing rate can be calculatedby the server and then delivered to the dispenser display or thedispenser can internally calculate the dispensing rate. The displaycould be LED, LCD, or any other known displays in the art. In addition,the real-time hand hygiene rate can also be displayed on an externaldisplay to provide immediate confirmation to users that their dispensersare transmitting data properly. Other methods of notifying the user ofthe dispensing rate, e.g. text, email, social media, and the like.

When displaying the hand hygiene rate to the user on the display, it maybe desirable to display an accurate real time hand hygiene rate. Forexample, if the user's goal rate is 10 uses/hour, the system can collectthe current activations of the dispenser and divide by 6 minuteincrements and convert to hours by multiplying by 60. When the userfirst activates the dispenser to dispense alcohol gel or sanitizer therate would be: ⅙ minutes×60 minutes/hour=10 uses/hour. This wouldcontinue for 6 minutes. After 6 minutes the program would advance andthe denominator would change to 12 minutes. Therefore, if the user didnot perform any more hand cleansings the rate would be 1/12 minutes×60minutes/hour=5 uses/hour. If the user performed 2 more cleansings duringthis period the rate would be calculated as 3/12 minutes×60minutes/hour=15 uses/hour. Using the six minute increments would smooththe values that would be displayed.

Determining Compliance and Hand Hygiene Rates

The hourly hand hygiene rate can be calculated by taking the number ofdispenser activations divided by the working time on the shift in hoursand minutes. For example, hand hygiene rate=100 dispenser activations/10hours worked on the shift=10 dispenser activations/hour. For example,the rate for 75 dispenser activations over 8 hours and 35 minutes ofworking time is calculated as 75 activations/(8 hours×60 min)+35 min×60min/1 hr=8.7 activations/hour

The working time used to calculate the hand hygiene rate can beestablished by the electronically detected time spent by users within adiscrete clinical area. The working time may or may not account for theuser leaving the discrete clinical area for breaks, lunch, or to work inother areas. Electronically detected (i.e. radio frequency, infrared,ultrasound, others) duration can be established by one or more of thefollowing:

(1) calculating the time between electronically detected entry into adiscrete clinical area and comparing that time to the time ofelectronically detected exit out of the discrete area,

(2) periodic electronic detection of electronics carried by the userwithin the discrete area every N seconds/minutes (for example, personaldispenser electronics send out an RF signal every 15 seconds to a datacollector that has a range that approximates the area of the care unit),

(3) optionally using electronic motion detection in the electronicscarried by the user to eliminate time periods when the electronics arenot active on a user, or

(4) downloading data from an integrated employee time keeping system ordatabase.

In another exemplary embodiment, the hand hygiene rate can benormalized. For example, the mean of the best three of the last sixshift rates can be used to determine the user's hand hygieneperformance. This accounts for shifts that are low due to factors beyondthe user's control, for example, taking care of patients that are onisolation precautions or taking care of patients with C. difficileinfections which require soap and water hand hygiene. Also isolating theprevious six shifts keeps the rate recent and relevant as this typicallycovers a one and one half to two week period. Using the mean alsofactors in low or high performance.

In another exemplary embodiment, the hand hygiene rate of the unit orgroup of workers can be normalized by taking the median rate of all ofthe workers in the particular unit or group. Taking the median rates ofthe unit or group can account for the outliers at the low end or highend of the hand hygiene rate range.

In another embodiment, the monitoring system can be configured todetermine whether the user attempts to “game” or cheat the system. Forexample, the system can review whether the user used the dispenserseveral times during a short duration during the shift, such as at theend of the shift when the user may want to “catch up” their goal rate.In another example, a run chart type system can be used. A run chart canevaluate the data and the likelihood that the data is “in control.” Inthis example, the system can be configured to detect trends andout-of-control conditions with data over time.

In another example, the system could also review hand hygiene rates todetermine appropriate patterns associated with hand hygiene. This couldbe accomplished by correlating the events with known work patterns toaccount for types of patients being seen, treatments, other activities,etc. Moreover, the system could communicate and correlate with othersystems, such as the time clock system to correlate times with workpatterns, for example, and may discount time for lunch periods, breaks,etc.

The shift data is evaluated by calculating the time between consecutiveactuator activations. Each data point is compared to the mean of all thepoints combined. If X consecutive points fall below the mean, itindicates an anomaly in the way the user is using his/her dispenser.This user may be “flagged” and additional shift data can be analyzed tolook for a pattern of “cheating.” The X consecutive points and number ofshifts to review are under evaluation. For example, in a typical controlchart if 9 consecutive points are below the mean the system is “out ofcontrol.” If this pattern is during a particular part of the shift, forexample, near the end, it may also be flagged for cheating.

In another exemplary embodiment, the system can track the movement ofthe dispenser to see whether the user is cheating by detecting the timebetween dispenser movements. For example, if a user leaves the dispenseron a counter and only picks it up infrequently to use it could appearthat the rate is high, but because of the minimal movement of the sensorthis can be detected.

In another exemplary embodiment, the hand hygiene rate can be assignedto a clinical date to coincide with work shifts that run fromapproximately 7 AM to 7 AM the next day so night shift users don't haveto see their shift rate broken up over two dates. The electronic timestamp records from the dispenser transmitter are used to set theduration based on when the shift started approximately. If a user startsa day shift before the 7 AM shift change or stays after a 7 AM nightshift end, the records are joined with the actual shift date worked.

In another exemplary embodiment, the system can base coaching tips basedon users' hand hygiene data compared to established champion orexemplary hand hygiene data patterns based on position, setting, andduties. Champion or exemplary data pattern templates are established byobservation and personal dispenser data collection for a number ofchampions for a given position and setting. The patterns can representcommon segments of duties performed. The timing between appropriate handhygiene events can be approximated into templates.

Ongoing user data from similar positions and settings can be compared tothese patterns. A series of pattern alignments can signify exemplaryhand hygiene performance prompting compliments and encouragement incommunications such as emails or text messages. A lack of alignmentcould potentially elicit further review of the pattern misalignments togenerate intelligent suggestions to promote specific hand hygienebehaviors. The data could also be combined with other electronic datasuch as motion detection or radio/infrared/ultrasound detection ofentering/exiting discrete areas. For example, the data pattern couldindicate a doctor is doing rounds on an ICU and failing to use thepersonal dispenser when approaching the next patient. An email could besent making the suggestion the doctor works harder to use the dispenserwhen approaching patients. Another pattern example is an ICU RN changinga catheter collection bag where there should be a series of hand hygieneevents before and after donning gloves. In this scenario the system canbe configured to send an appropriate reminder message to the user.

Providing User Feedback

As discussed above, the system can provide for user accountability incompliance with hand hygiene. In an exemplary embodiment, a performancemanager is intended to help the user be self-accountable to agreed-uponhand hygiene goals. However, if the user continues to exhibit poorperformance then he/she may lose anonymity and must be accountable to apeer and/or manager. The system can be configured to allow forflexibility in setting up the accountability structure and other methodsof holding the users accountable are contemplated.

In one exemplary embodiment, the performance manager can be configuredto send a notification to the user regarding the user's hand hygieneperformance. In one example, the performance manager can compare theuser's average rate to a predetermined goal rate over three (more orless) shifts. If the average rate is less than the goal rate, the usermay receive a warning and the warning level escalates with continuedperformance below the goal. This warning can be sent to the user viatext, email, dispenser display, kiosk, or any other known method ofcommunicating with the user.

Table 1 shows an exemplary embodiment of a method of providing userfeedback and ensuring user feedback. As shown below, the performancemanager has various levels of user performance. However, the number oflevels and the actions taken at each level may be modifiable by thesystem administrator within certain limits. That is, the administratormay be able to select the number of levels and the action for each levelfrom a menu when initiating the system. Depending on the level ofperformance, the system can be configured to notify the user of goodperformance, average performance, below average performance or requirethe user to take various actions to help encourage the user to complywith the facility's hand washing requirements. In one example, the goalhand hygiene performance rates can be based on published data from theCDC or other public health institutions.

In another example, the goal hand hygiene rates can be based on workpatterns for varied clinical roles. For example, a health care worker inan ER will have different duties and activity level than a health careworker in a doctor's office or intensive care unit. The work patternscan be analyzed with predetermined templates for each health care workertype e.g., the appropriate level of hand hygiene events for theparticular health care worker type. For example, the health careworker's hand hygiene event data can be compared to the templates forthe appropriate clinicians to automatically make suggestions on how toimprove appropriate clinical hand hygiene performance. These suggestionscan be made in the form of text, icons, or audible reminders on thepersonal hygiene dispensers, in emails or texts to the users or otherelectronic methods. The templates can be created by calculating idealhand hygiene rates for each worker type or from historical data from theparticular worker type.

TABLE 1 Performance Level Description Action and/or purpose Level 0Average rate is in No action taken or system sends compliance with thegoal notification that user is in compliance rate with the goal rate. Anotification could be sent to the user to indicate the user hasillustrated exemplary performance of hand hygiene. Level 1 Average rate(see above) is Warns the user that their rate has been less than goalrate below the goal rate. The system can be (minimum of six shiftsconfigured to send the warning via e- before the system activates) mail,text, a touch screen “kiosk” on the unit to access the information orany other known method. For this and all subsequent levels the user thenhas three shifts to get their average up to the goal rate, however, ifthey achieve the goal rate for a shift, but their average is still belowgoal, they earn an additional shift to get their average up to the goal.Level 2 Average rate is less than The user is prompted to go to the webgoal for three additional based “Issue Handler,” a guide to help shifts,six total shifts. the user explore issues that may be keeping him/herfrom achieving the goal rate. They must respond that they have consultedthis tool. The user then has three shifts to get their average up to thegoal rate. Level 3 Average rate is less than The user must review aninstruction, goal for three additional audio file, a web video, etc. andpass a shifts, nine total. quiz on the information. The content can beplaced on a web based-hand hygiene system/server. Level 4 Average rateis less than The user must set up a meeting with a goal for threeadditional peer counselor or manager to discuss shifts, twelve total.his/her hand hygiene performance and develop an improvement plan. Thiscan be the first time the user has lost anonymity in the compliancesystem. Level 5 Average rate is less than At this level the user may berequired to goal for three additional meet with a manager, infectionshifts, fifteen total. preventionist, etc. or may receive a formalreprimand. The consequences are decided upon prior to implementation ofthe system and can be ultimately decided by the administration of aparticular facility.

In another exemplary embodiment, the performance manager can send emailsor surveys to low-performing users to elicit their response to questionsto identify behavior change barriers. The behavior change barriers arebased on user objections from past experience or are designed to helppinpoint components of behavior-change models such as Health BeliefModel, Theory of Reasoned Action, Theory of Planned Behavior,Self-Efficacy, and the Transtheoretic Model. Based on the user's answer,the system can direct users to information that addresses their specificobjections. All answers are stored in a database to be used to analyzethe barriers for a given user, care unit, hospital, or region.

In one exemplary embodiment, a performance coach sends regularcommunications to users to encourage improvements or to sustain goodperformance. Exemplary communications are depicted in FIGS. 9-12B. Eachcorrespondence may be in the form of email, printed report, textmessage, or other method of correspondence. These communications may besent after each recorded shift or day of hand hygiene data or after aregular sequence of days or shifts, for example after three shifts. Asdepicted in FIGS. 9, 10, and 12, these communications may include asummary report of the user's hand hygiene performance for the mostrecent shifts or days of hand hygiene recorded. Based on the most recentperformance, the correspondence can be based on a decision matrix.

In one example, the decision matrix can be a set of prioritized steps.The steps can initiate a correspondence to recognize conditions ofperformance over time. For example, a top priority may be to firstrecognize any form of good performance such as consistent performanceabove the goal rate, a recent shift performed at or above a goal rate,or an improved performance above the user's average even if below apredetermined goal. The next level of priority may be a reminder thatperformance is below a goal that can be sent only once initially andthen once per performance dip.

In one exemplary embodiment, as illustrated in FIG. 11, one of thesubsequent performance coach steps can be to provide a periodiccommunication that elicits a response to a question with multiple choiceanswers based on common barriers to successful hand hygiene adherence. Ashort question with a limited number of multi-choice answers may beasked in an email and one or more of the answer selections may branch toan additional question with additional multiple choice answers from aweb page. Selection of those answers may also branch to another questionand set of answers in another web page. Ad-hoc answers can also beentered in text boxes. All answers are recorded and assigned to the userin a database to be used to categorize future tips or suggestions aimedat addressing the common barriers to proper hand hygiene. Ad-hoc textresponses are stored for later review and may be used to expand thequestion and answer set.

As shown in FIGS. 12A and 12B, subsequent prioritized steps in thedecision matrix may be to send a series of common tips, quotes, ormotivational text. These may be categorized by recent responses to themultiple choice questions aimed at identifying common hand hygienebarriers. These categorized tips, quotes, or suggestions may be selectedfrom within a pool randomly or stepped through sequentially as to avoidrepeats. These intelligent tips, quotes, or suggestions may also beplaced in the subject line of an email or sent as text messages. Userresponses to the questions may also be stored to be used to tailor thecontent of educational online courseware the user may be asked by emailor text to perform. The user responses may also be used to initiatecorresponding related real-time reminders using the audio, light, ortactile or other output devices. An example of the performance coachdecision matrix is shown in FIG. 17.

In one exemplary embodiment, the personal dispenser light, audible, ortactile electronic circuit can be used to help train the user to newhand hygiene behaviors. This reminder system can use all available datato establish activation patterns of the reminder by light, audible, ortactile circuit. The circuit could recognize the personal dispenser hasentered a patient care area and then activate the reminder every Nminutes. N would correspond to the goal rate for that user based onposition and setting, for example, an ICU RN with a goal rate of 8initiates a reminder every 5 minutes when in the immediate patientsurrounding. The timing of the reminder can also be based on establishedchampion hand hygiene data patterns based on position, setting, andduties. The use of the reminder can also be based on user answers toperformance coach questions.

Displaying of Hand Hygiene Performance Feedback

There are a number of ways that hand hygiene compliance data can bedisplayed to the users and management for a particular facility or setof facilities. FIGS. 4-8 depict a few exemplary displays for providingfeedback.

As shown in FIGS. 4 and 5, the system can be configured to display theuser or caregiver's average rate, the number of users or caregiversmeeting the hand hygiene goal, and the number of users or caregiversbelow the goal. The display can also be configured to display eachindividual user rate average, last shift rate, last shift date, time indiscrete clinical areas, and goal rate by ID number to maintainconfidentiality. The system can also be configured to track certaingroups of individuals and to determine average group hand hygiene rates.In the example shown in FIG. 4, the teams are categorized by color, forexample, Blue, Pink, Orange, Purple, and Yellow. As shown in the examplein FIG. 4, the Blue group has the highest rate of performance. This mayhelp individual users to try to get their rates higher to compete withother groups within a particular facility.

As depicted in FIGS. 6 and 7, the system can be configured to displaycompliance trends over a predetermined time period and top rates forparticular individuals, groups, units and professionals such as nursesor clerks.

As shown in FIG. 8, the user can get his or her personal hygiene rateover a predetermined or specified time period to view his/her compliancerate over various shifts.

FIGS. 13A-13G show another exemplary personal hand hygiene dispenser308. FIG. 13A generally shows a front perspective view of the examplehand hygiene dispenser 308. FIG. 13B shows a side perspective view ofthe example hand hygiene dispenser 308. FIG. 13C shows a rearperspective view of the hand hygiene dispenser 308. FIG. 13D shows abottom perspective view of the hand hygiene dispenser 308. FIG. 13Eshows the hand hygiene dispenser with the container 312 removed. FIG.13E shows a rear view of the hand hygiene dispenser 308 with thecontainer 312 removed. FIG. 13G shows another rear perspective view ofthe hand hygiene dispenser 308 with the container 312 removed.

The dispenser 308 can include the same or similar features and caninclude the same or similar functionality as the hand hygiene dispenseras discussed herein in relation to FIGS. 3-3D in which like referencenumerals indicate similar elements.

As shown in FIGS. 13A-13G, the personal hand hygiene dispenser 308generally includes a housing 309 which includes an internal recess 311(shown in FIG. 13B) for holding a bottle or container 312 having aninternal reservoir for hand sanitizer. The internal recess is connectedwith a top recess 313 (shown in FIG. 13G) for inserting the container312 into the housing and a bottom recess 321 (shown in FIGS. 13D and13F) for receiving a spout 317 which defines an opening 317 a of thecontainer 312. Additionally the housing 309 can be provided with acircular opening 319 for viewing the container 312, which provides theuser with a visual indication of how much hand sanitizer is left in thecontainer 312. The opening 319 can also provide direct contact with thecontainer 312 and the user's hand such that the hand sanitizer willeasily dispense from the container 312.

Within the recess 311 of the housing 309, an input or sensor 310 isincluded for sensing when a hand hygiene event occurs. As shown in FIG.13E-13G, the input 310 can be located within the housing 309. Anattachment mechanism 315 can also be included for attaching thedispenser 308 to a health care worker's clothing or lanyard.

Additionally, like in the above example, the dispenser 308 may alsoinclude an RF, IR, or other known type of wireless transmitter, memorycircuit, and a light indicator for indicating a hand hygiene event oncethe input 310 is depressed. Additionally, the hand hygiene dispenser 308can include a processor, RAM, ROM, and a memory for storage to provideinstructions to the processor for enabling the hand hygiene dispenser308 to perform various functions or for storing the dispensing actions,which can be downloaded at a later time. This minimizes the use of powerby the hand hygiene dispenser 308.

Alternatively or in addition, the hand hygiene dispenser 308 can beconfigured to communicate with various connection points throughout afacility. For example, the above connections can be made via theinternet, Ethernet, Bluetooth, Wi-Fi, cell modems, or infrared. In onespecific example, the above connections can be made using a reducedpower consumption type of communication or low-power radio signals,e.g., Bluetooth Low Energy (also referred to as “Bluetooth LE,”“Bluetooth Smart,” or “BLE”), Zigbee, and ISM. In one example, the ISMcan be an NFC connection. For example, the dispenser computer can storea number of previous hand hygiene events and then transmit the handhygiene events to the various connection points throughout the facilitywhen the dispenser is within a certain range, e.g., 5-100 meters. Otherknown techniques for transferring the data from the dispensers 308 tothe server are also contemplated.

As shown in FIG. 13D, the contents of the container 312 are squeezedthrough an opening 317 a in the bottom of the dispenser 308 to dispensethe hand sanitizer located in the container 312. In addition todispensing hand sanitizer from the dispenser 308, squeezing thecontainer 312 also activates the input 310. As shown in FIGS. 13E-13G,the input 310 is located within the housing 309 so that the container312 abuts the input 310. As shown in FIG. 13E, the container 312 can beincluded with opposing walls 323. When the container 312 is placed inthe hand hygiene dispenser housing 309, one of the walls 323 will beplaced into contact with the input 310 and the other wall will bepartially viewable through the opening 319.

In this way, when the user squeezes the housing 309 and the container312 to dispense hand sanitizer, the wall 323 of the container 312 incontact with the input 310 will displace the input 310, which signalsthat a hand hygiene event has occurred. Moreover, when the input 310 isdisplaced or actuated, a hand hygiene event will be stored in the memoryof the hand hygiene dispenser 308. The hand hygiene event can be laterdownloaded or transmitted from the hand hygiene dispenser 308 asdiscussed herein. In one specific example, the input 310 sends a signalto the processor, which stores the hand hygiene event in the memory ofthe dispenser 308 to record the event for later downloading to acomputer, for example, when the hand hygiene dispenser 308 is synced orsent to a receiving and transmitting station as discussed below.

In alternative examples, it is contemplated that when the container 312is squeezed, the input 310 is pressed simultaneously to send a signalvia a transmitter and antenna to indicate to the server that a handhygiene event has occurred. The transmitter can be connected to theinput 310, which sends a signal to the network indicating that a handhygiene event has occurred. Additionally, the actuation of the input 310may be associated with a time interval that is stored in the memorycircuit and represents the time and date of each activation.

Locating the input 310 within the housing 309 provides a more accuratereading of when a hand hygiene event occurs. For example, it preventsaccidental actuation of the input 310 and prevents users from cheatingby preventing the detection of a hand hygiene event, unless thecontainer is also fully squeezed within the housing 318. It alsoprovides a more robust design of the dispenser 308 since the input 310is not externally exposed in anyway. As discussed below in relation toFIGS. 14A and 14B, in one example, the input 310 can be configured as apush button switch, which can be an analogue or electrical switch andmay include one or more relays or transistors. However, other knownswitch types and sensor types are contemplated.

Like in the above example, the container 312 can be a refillablereservoir or can be implemented as a replaceable cartridge. As shown inFIGS. 13E-13G, the container 312 can be removed from the housing 318 andreplaced with a full container 312 or the container 312 can be refilledwith hand sanitizer and placed back in the housing 308. In particular,similar to the example discussed above, as shown in FIGS. 13F and 13G,the container 312 can be inserted and removed through the top recess 313and is held into place in the housing 318 by an interference or frictionfit.

Additionally, the dispenser 308 may include an accelerometer fordetecting user motion as discussed in further detail below. This allowsthe system to determine whether the dispenser 308 is in use to assistwith proper calculation of a hand hygiene rate. For example, if theaccelerometer detects motion of the dispenser, the system 308 can detectthat a user is wearing and using the device. However, if theaccelerometer is not detecting any motion, then it can be determinedthat the user has removed the dispenser from his/her clothing and thedispenser is not in use.

In yet another example, as in the examples discussed above, thedispenser 308 may also include a display screen (not shown) fordisplaying performance data, such as the user's average dispensing rate,to the user. The display can also display data from a group, such as aunit or facility hand hygiene rate, and other current and historicaldata. The hand hygiene dispenser 308 can include various input devicessuch as buttons, keys, or a touchscreen. In one example, an input devicecan provide the user with the ability to scroll through current andhistorical hand hygiene data and may also have an input for turning thedisplay on and off to maintain privacy. In one particular example, thedisplay screen can be configured as a touch screen providing aninterface for viewing the desired content.

FIGS. 14A and 14B depict an exemplary printed circuit board (PCB) 450for a hand hygiene dispenser, where FIG. 14A shows a front perspectiveview and FIG. 14B shows a rear perspective view of the PCB. As shown inFIGS. 14A and 14B, the PCB 450 can include an LCD screen 452, an LCDcontrol button 454, an accelerometer 456, an antenna 458, inputs 460, amicroprocessor 462, and a battery 464. Each of the LCD screen 452, theLCD control button 454, the accelerometer 456, the antenna 458, theinputs 460, and the battery 464 can be connected to the microprocessor462, which can be configured to receive and send inputs to each of thePCB components.

In accordance with the examples above, the LCD control button 454 can beconfigured to turn the LCD screen on for viewing the various handhygiene data discussed herein, and the LCD control button can beconfigured to turn the LCD screen off for privacy purposes. The LCDcontrol button 454 can also be configured with scrolling and togglingcapabilities to view various portions of hand hygiene data such aspersonal hand hygiene rates, group hygiene rates, or facility hygienerates.

Also the PCB 450 can include an antenna 458, which can be configured towirelessly transmit or receive hand hygiene information via any wirelesstransmission protocol. In one example, as discussed herein thetransmission protocol can be a form of low energy transmission, such asBluetooth Low Energy (also referred to as “Bluetooth LE,” “BluetoothSmart,” or “BLE”), Zigbee, or ISM. The PCB 450 may also include theaccelerometer 456 for detecting motion of the hand hygiene dispenser308.

The accelerometer 456 can include various components for convertingmechanical motion to electrical signals, such as piezoelectric,piezoresistive, and capacitive components. The microprocessor 462 canreceive signals from the accelerometer 456 indicating when the handhygiene dispenser 308 is undergoing movement. Further, themicroprocessor 462 can include instructions that determine the length ofan evaluation period based on the amount of time that the accelerometeris undergoing movement, and after a predetermined amount of time or timeinterval, the microprocessor 462 can determine that the hand hygienedispenser 308 is no longer in use. In this way, the hand hygienedispenser 308 can be configured to more accurately determine the handhygiene rate.

In another example, the accelerometer data can also be used to determinehow many steps are taken in a day by the health care worker. This datacan be utilized to determine whether a user is applying an appropriateamount of hand sanitizer during a shift. Additionally the accelerometerdata can be used to trigger a signal that can be sent to the userthrough the user's hand hygiene device. For example, if a user is stopsto see a patient and is stationary for a predetermined amount of time,the accelerometer can detect the user has stopped and send a remindersignal to the user to dispense hand sanitizer from the hand hygienedispenser.

In another example, the accelerometer data can be stored in a databaseand can be used to identify work and motion patterns for varied clinicalroles. For example, a health care worker in an ER will have differentactivity level than a health care worker in a doctor's office orintensive care unit. The work and motion patterns can be analyzed withpredetermined templates for each health care worker type e.g., theappropriate level of hand hygiene events for the particular health careworker type. For example, the health care worker's motion and handhygiene event data can be compared to the templates for the appropriateclinicians to automatically make suggestions on how to improveappropriate clinical hand hygiene performance. As discussed herein,these suggestions can be made in the form of text, icons, or audiblereminders on the personal hygiene dispensers, in emails or texts to theusers or other electronic methods.

The templates can be created by calculating ideal hand hygiene rates andactivity level for each worker type or from historical data from theparticular worker type. For example, the motion information and handhygiene information can be collected and used to identify motion andhand hygiene patterns. The motion and hand hygiene patterns are thenused to create templates for evaluating hand hygiene data.

The PCB 450 can also be provided with various inputs 460 that can beconfigured to detect hand hygiene events. In one example, the inputs 460can be configured as event buttons. The inputs 460 detect when the userdispenses hand sanitizer from the hand hygiene dispenser. In thisexample three inputs 460 can be provided for redundancy purposes toensure that a hand hygiene event is detected. However, it is alsocontemplated that one or two inputs could be included on the PCB 450. Inmultiple input examples, it is contemplated that a control circuit canbe included to ensure that the pressing of multiple inputssimultaneously does not count for more than one hand hygiene event. Forexample, instructions can be stored in the memory and provided to theprocessor to count only one hand hygiene event when the inputs aretriggered with control logic. Additionally, the control circuit may onlycount one hand hygiene event when the inputs 460 are triggered at closeintervals. In other examples, the switches can be wired in parallel suchthat only one event is detected. The circuit could also be provided withone or more relays to ensure that the multiple switches do not detectmore than one hand hygiene event. In one example, the inputs 460 can beconfigured as push button switches and can be analogue or electricalswitches and may include one or more relays or transistors. However,other known switch types are contemplated.

As shown in FIG. 14B, the PCB can also be included with a rechargeablebattery 464, such as a lead-acid, nickel cadmium (NiCd), nickel metalhydride (NiMH), lithium ion (Li-ion), and lithium ion polymer (Li-ionpolymer) type batteries or any other batteries suitable for consumerelectronic devices. The battery 464 can be recharged at the end of ashift or day by plugging the hand hygiene dispenser into an outlet orcomputing device (e.g. USB). For example, the hand hygiene dispenser canbe provided with a power adapter for supplying power to internalcharging circuitry within the hand hygiene dispenser for the battery464. Additionally, it is also contemplated that facilities can beoutfitted with charging kiosks that can be configured to charge the handhygiene dispensers throughout the workday, such as during breaks of thehealthcare workers.

FIGS. 15A-15D show another exemplary personal hand hygiene dispenser508. FIG. 15A generally shows a front perspective view of the examplehand hygiene dispenser 508. FIG. 15B shows another front perspectiveview of the example hand hygiene dispenser 508 in another configuration.FIG. 15C shows a rear perspective view of the hand hygiene dispenser508. FIG. 15D shows a rear perspective view of the hand hygienedispenser 508 with the container 512 removed.

The dispenser 508 can include the same or similar features and caninclude the same or similar functionality as the hand hygiene dispenseras discussed herein in relation to FIGS. 3-3D and 13A-13G in which likereference numerals indicate similar elements. In this example, the handhygiene dispenser 508 can include a display screen 540.

The display screen 540 can be configured to display screen performancedata, such as the user's average dispensing rate, to the user. Thedisplay screen 540 can also display data from a group, such as a unit orfacility hand hygiene rate, and other current and historical data. Thedisplay screen 540 can also be configured to indicate whether the useris meeting their hand hygiene goals with various symbols or icons 544.In one example, the icon 544 can be a “thumbs up” to indicate that theuser is in compliance, or a “thumbs down” to indicate that the userneeds to clean his/her hands more. The display screen 540 can alsoprovide certain other alerts to the user such as low battery, low handsanitizer amount, etc. It is also contemplated that the display screen540 can be configured to provide various different views of data andalerts for the user.

Additionally, the display screen 540 can be provided with an inputdevice 542, which can provide the user with the ability to scrollthrough current and historical hand hygiene data and may also beconfigured to turn the display on or off to maintain privacy. It iscontemplated, however, that the hand hygiene dispenser 508 can includevarious other input devices such as buttons, keys, or a touchscreen. Forexample, the display screen 540 can be configured as a touch screenproviding an interface for viewing the desired content.

Similar to the example shown in FIGS. 13A-13G, the personal hand hygienedispenser 508 generally includes a housing 509 which includes aninternal recess 511 (shown in FIG. 15D) for holding a bottle orcontainer 512 having an internal reservoir for hand sanitizer. Theinternal recess is connected with a top recess 513 (shown in FIG. 15D)for inserting the container 512 into the housing 509 and a bottom recessfor receiving a spout, which defines an opening of the container 512.Additionally the housing 509 can be provided with a circular opening 519for viewing the container 512, which provides the user with a visualindication of how much hand sanitizer is left in the container 512.

Again similar to the above example, within the recess 511 of the housing509 an input or sensor 510 is included for sensing when a hand hygieneevent occurs. As shown in FIG. 15D, the input 510 can be located withinthe housing 509. An attachment mechanism 515 can also be included forattaching the dispenser 508 to a health care worker's clothing orlanyard.

The example hand hygiene dispensers can be configured to communicatewith any of the devices discussed herein. In one particular example,several computing devices, which can include the same or similarfeatures and functionality as discussed herein in relation to FIGS. 1and 2, may be provided in the network and set up as receiving andtransmitting stations. The receiving and transmitting stations can bedispersed throughout a facility and can form part of a hand hygienemonitoring system. It is contemplated that any computing device could beconfigured as a receiving and transmitting station, including anycomputing device within the facility network, and the receiving andtransmitting stations may also include an optional display such as anLCD screen. Each of the receiving and transmitting stations can beconfigured to receive and transmit hygiene data to and from theplurality of hand hygiene dispensers and can display certain data. Forexample, the hand hygiene dispensers can be configured to send handhygiene event data to the receiving and transmitting stations. Inanother example, the receiving and transmitting stations can beconfigured to transmit various information to the hand hygienedispensers, such as personal hand hygiene rates, group hand hygienerates, messages regarding hand hygiene compliance and goals, etc.

In one particular example, one or more computing devices can beconfigured as receiving and transmitting stations by outfitting one ormore computing devices with antennas. The antennas can be configured toreceive and transmit hand hygiene data to and from the hand hygienedispensers via any wireless transmission protocol, including thewireless transmission protocols discussed herein. In one example, asdiscussed herein, the transmission protocol can be a low energytransmission protocol, such as Bluetooth Low Energy (also referred to as“Bluetooth LE,” “Bluetooth Smart,” or “BLE”), Zigbee, or ISM. In oneexample, the antenna can be connected to the computing device via a USBtype connection. Additionally, the hand hygiene dispensers and/or thereceiving and transmitting stations can be configured to automaticallydownload hand hygiene data from the hand hygiene dispensers or transmithand hygiene information when the hand hygiene dispenser is within acertain range of a particular receiving station. For example, if a useris out of range from a receiving station, event and motion data can beretained in the user's hand hygiene dispenser until the user is within apredetermined range of the receiving and transmitting station, e.g.,5-100 meters. When the user is within the predetermined range, the datawill be automatically downloaded from or transmitted to the hand hygienedispenser.

The receiving and transmitting stations can also be configured to relaythe hand hygiene information from the dispensers to a network orinternet for viewing by the facility management and others to determinehand hygiene performance, compliance and areas of improvement.Additionally, the receiving and transmitting stations or the network canbe include a data collection module, which can be configured to collectdata from each of the hand hygiene dispensers and to store this datainto a database, such as an open source database, e.g., My SQL. Thereceiving stations can also be configured to collect all of the handhygiene data from all of the hand hygiene dispensers and to transmitthis data to a database, which can reside anywhere on the network.

In one exemplary embodiment, an internet-based (online) training systemis integrated with the system to help users learn how to best use thepersonal dispenser and measurement system. The online training programcan include text instruction as well as audio and video instruction andcommentary. Questions can be posed to the users and their responses canbe recorded in an associated database that corresponds with theirpersonal dispenser performance records. The responses can be used totailor additional online instruction. Users can awarded pass or failstatus of the training material based on their correct response rateagainst an established acceptable percentage of correct answers.

In one exemplary embodiment, a certification component can useperformance and/or online training status criteria to achieve andmaintain a certification status. Ongoing certification status can bebased on established acceptable performance criteria. Also there can bemultiple levels of performance certification.

In one example, the certification component can be based on users'personal dispenser performance data minimum use rate criteria. Inparticular, certification status can be based on a minimum number ofshifts logged by a user's personal dispenser and a given ratio of shiftuse rates at or above a given goal rate. The primary performancecriteria can be 1) a minimum number of shifts recorded by the user'spersonal dispenser during a given time interval, e.g., six shifts amonth, 2) a minimum percentage of shifts at or above the user's goalrate during a given time interval i.e. one third of the shifts during amonth are at or above the goal rate of 6.0. Rating levels can be basedon the percentage of shifts at or above goal, e.g., “Proficiency” ratingis for one-third to two-thirds of shifts at or above goal and“Excellence” rating is for more than two-thirds of shifts at or abovethe goal rate. An average of two or more shift rates during a timeperiod can also be used to establish certification ratings e.g.,one-third of the best shifts during a month are averaged—a rate of 6.0to 8.0 for “Proficiency” and over 8.0 for “Excellence.” Other criteriaand time periods can be used to establish certification levels as well.Users can request and/or be provided with an electronically generatedcertificate that can be electronically issued to users, for example asshown in FIG. 16.

The examples discussed herein may assist in improving hand hygienebehavior by (1) providing a safe and anonymous method for health careproviders to manage their own hand hygiene, (2) giving the health careprovider regular feedback of their hand hygiene performance in the formof a hand hygiene rate, which can be visible to the users on thedispensers, posted online, sent to the user etc., and/or (3) providingcoaching in the form of (a) encouragement of good performance, (b)reminders regarding lapses in hand hygiene performance, and/or (c)remediation and accountability for poor performance. Additionally, theexamples discussed herein can give leadership and management theopportunity to be involved to encourage health care professionals topractice good hand hygiene.

III. Features of Hand Hygiene Compliance Method According to Examples ofthe Disclosure

In an exemplary embodiment, a method may include tracking the dispensingof a plurality hand hygiene dispensers having hand sanitizer and eachhand hygiene dispenser being associated with an individual user. Themethod can include one or more of the following steps: determining by aprocessor dispensing rates of the plurality of hand hygiene dispensersfor a plurality of predetermined time periods; identifying each of theplurality of the hand hygiene dispensers with an individual user;determining by a processor a predetermined number of highest dispensingrates out of the plurality of predetermined time periods and calculatingan average dispensing rate based on the predetermined number of highestdispensing rates; displaying the dispensing rates of the plurality ofhand hygiene dispensers; and notifying an individual user regarding theindividual user's performance

In another exemplary embodiment, the method can include the followingsteps: displaying the individual user's dispensing results on a screenof the user's hand hygiene dispenser, and reviewing the dispensing ofone or more of the plurality of hand hygiene dispensers over apredetermined time period to determine whether one or more of theplurality of hand hygiene dispensers has a higher dispensing rate todetect cheating by the user. The plurality of hand hygiene dispenserseach have a wireless transmitter, and the wireless transmitter cantransmit dispensing data.

The method may also include detecting whether the user is using anappropriate amount of hand sanitizing solution. In one example, theplurality of hand hygiene dispensers can each have a reservoir, and thenumber of dispenser activations are detected and compared with an amountof hand sanitizer in the reservoir to determine if an appropriate amountof sanitizer is being used by the user. The plurality of hand hygienedispensers may be provided with an indicator that signals when the userdispenses hand sanitizer. The predetermined time periods may, in oneexample, include work shifts for the users, and the number ofpredetermined time periods may be greater than or equal to six. Thepredetermined number of highest dispensing rates can be greater thanthree. The method may further include assigning a rating to eachindividual user based on the user's average dispensing rate and caninclude providing the user with a predetermined message based on certainratings of the user.

In another exemplary embodiment, an apparatus can include a processorfor executing computer-executable instructions; and one or more memoriesstoring the computer-executable instructions that, when executed, causethe apparatus to perform a method. The method may include one or more ofthe following steps: determining by a processor dispensing rates of theplurality of hand hygiene dispensers for a plurality of predeterminedtime periods; identifying each of the plurality of the hand hygienedispensers with an individual user; calculating an average dispensingrate based on a predetermined number of dispensing rates; displaying thedispensing rates of the plurality of hand hygiene dispensers; andsending a notification to an individual user regarding the individualuser's hand hygiene performance. The notification could inform theindividual user that his/her average dispensing rate falls below atarget threshold rate. In addition or alternatively, the notificationcould be associated with exemplary performance of hand hygiene. Themethod can also include displaying the individual user's dispensing rateon a screen of the user's hand hygiene dispenser and/or reviewing thedispensing of one or more of the plurality of hand hygiene dispensersover a predetermined time period to determine whether one or more of theplurality of hand hygiene dispensers has a higher dispensing rate todetect cheating by the user.

In one example, the plurality of hand hygiene dispensers can each have aRF transmitter, and the RF transmitter signals that the dispenser hasbeen actuated or may transmit performance data to a centralized trackingsystem. The apparatus further comprises detecting whether the user isusing an appropriate amount of hand sanitizing solution. The pluralityof hand hygiene dispensers can each have a reservoir, and the number ofdispenser activations can be detected and compared with an amount ofhand sanitizer in the reservoir to determine if an appropriate amount ofsanitizer is being used by the user. The plurality of hand hygienedispensers can be provided with a visual, audible or tactile indicatorthat indicates when the user dispenses hand sanitizer and the event hasbeen transmitted to the computer system. The apparatus can furtherinclude assigning a rating to each individual user based on the user'saverage dispensing rate and providing the user with a predeterminedmessage based on certain ratings of the user. The dispensing of handhygiene solution could also be stored in the dispenser computer fordownload at a later time.

In another exemplary embodiment, a computer program product, may includea computer usable medium having a computer readable program codeembodied therein, the computer readable program code may be adapted tobe executed by a processor to implement a method. The method may includeone or more of the following steps: determining by a processordispensing rates of the plurality of hand hygiene dispensers for aplurality of predetermined time periods; identifying each of theplurality of the hand hygiene dispensers with an individual user;calculating an average dispensing rate based on a predetermined numberof dispensing rates; displaying the dispensing rates of the plurality ofhand hygiene dispensers; and notifying an individual user if the averagedispensing rate falls below a target threshold rate.

The computer program can also include instructions for displaying theindividual user's dispensing rate on a screen of the user's hand hygienedispenser and/or reviewing the dispensing of one or more of theplurality of hand hygiene dispensers over a predetermined time period todetermine whether one or more of the plurality of hand hygienedispensers has a higher dispensing rate to detect cheating by the user.The computer program product can further include detecting whether theuser is using an appropriate amount of hand sanitizing solution. Theplurality of hand hygiene dispensers can each have a reservoir, and thenumber of dispenser activations may be detected and compared with anamount of hand sanitizer in the reservoir to determine if an appropriateamount of sanitizer is being used by the user. The computer programproduct can also include instructions for assigning a rating to eachindividual user based on the user's average dispensing rate.

In another example, a computer-implemented method for trackingdispensing of a plurality hand hygiene dispensers having hand sanitizereach hand hygiene dispenser being associated with an individual user mayinclude determining by a processor user IDs and associating the user IDswith the plurality of hand hygiene dispensers; displaying anonymouslyeach user ID to each user; determining by a processor dispensing ratesof the plurality of hand hygiene dispensers; displaying the dispensingrates of the plurality of hand hygiene dispensers; and sending anotification to an individual user regarding the individual user's handhygiene performance. The notification may be provided anonymously to theuser using the individual user's user ID. A real-time reminder can besent after a predetermined time period when one of the plurality ofdispensers are electronically detected within a predetermined area andwhen not used within predetermined time period. The predetermined timeperiod can be based on usage patterns established by exemplary user handhygiene data. The exemplary hand hygiene data can be based on position,setting, and duties of the user.

The embodiments disclosed herein can be applied within hospitals andother healthcare institutions of various sizes including, for example,clinics, doctor's offices, kiosks, or temporary set-ups (e.g. stores orshopping malls) for tasks as simple as shots for influenza orcholesterol screenings. While some of these settings might not berequired to comply with regulatory hand washing protocols or compliancerequirements, the embodiments disclosed herein may be useful in theseenvironments. Another example is setups for handling disasters,epidemics or other circumstances in which large outdoor areas arededicated, at least on a temporary basis, to treat a variety ofpatients. For certain types of treatment, it may be important forhealthcare workers to comply with strict hand washing guidelines and tomonitor compliance in a real-time basis.

It is contemplated that the embodiments and concepts disclosed hereincould also be implemented outside of hospitals and other healthcareinstitutions in arenas where hand hygiene is important to preventtransmission of diseases. For example, the embodiments disclosed hereincould also be implemented in the food service industry, the foodprocessing industry, etc.

In another example, a system may include a plurality of hand hygienedispensers, where each hand hygiene dispenser can include a housingconfigured to receive a container adapted to store hand sanitizer. Thehousing may include an input for detecting hand sanitizing events whenhand sanitizer is dispensed from the container, and the input may belocated within the housing. The housing may also include a memory forstoring hand sanitizing events, and an accelerometer for recordingmotion information and for determining whether the hand hygienedispenser is in use. Each hand hygiene dispenser may be configured tocommunicate to a network via a low energy transmission protocol.

In one example, the container can be configured to be squeezed todispense sanitizer and to actuate the input within the housing. Thecontainer may define a wall, the wall can be placed adjacent the inputsuch that the wall contacts the input and actuates the input when theuser dispenses the hand sanitizer stored within the container. Each ofthe hand hygiene dispensers may include a display for displaying handhygiene data. In one example, the low energy transmission protocol canbe low energy Bluetooth.

The system may also include a plurality of computing devices where eachcomputing device can include a display and may be configured to receivedata from the plurality of hand hygiene dispensers regarding when one ormore hand sanitizing events have occurred via the low energytransmission protocol and to display hand hygiene data. Each of the handhygiene dispensers can be configured to send the hand sanitizing eventsstored on the memory to one of the computing devices when the handhygiene dispensers are within a predetermined range of the one of thecomputing devices.

Additionally, the system can include a calculation module which can beconfigured to perform a method comprising: determining by a processor adispensing rate of one or more of the plurality of hand hygienedispensers for one or more predetermined time periods, and calculatingan average dispensing rate based on a predetermined number of dispensingrates. The calculation module can be configured to send a notificationto an individual user regarding the individual user's hand hygieneperformance. For example, the calculation module can be configured tosend a notification to one or more of the hand hygiene dispensers fordisplaying the notification. Additionally, the calculation module can beconfigured to identify each of the plurality of the hand hygienedispensers with an individual user. The calculation module can reside onthe plurality of hand hygiene dispensers, on the plurality of computingdevices, or at a remote location on the network or internet. Thecalculation module can also be configured to review the dispensing ofone or more of the plurality of hand hygiene dispensers over apredetermined time period to determine whether one or more of theplurality of hand hygiene dispensers has a higher dispensing rate todetect cheating by the user. The calculation module can be configured todetect whether an appropriate amount of hand sanitizing solution isused. The motion information from the accelerometer can be used toidentify motion and hand hygiene patterns, and the motion and handhygiene patterns can be used to create templates for evaluating handhygiene data.

In another example, a method may include one or more of: providing aplurality of hand hygiene dispensers, providing each hand hygienedispenser with a housing configured to receive a container adapted tostore hand sanitizer, providing the housing with an input for detectinghand sanitizing events when hand sanitizer is dispensed from thecontainer, placing the input within the housing, providing a memory forstoring hand sanitizing events, placing an accelerometer for determiningwhether the hand hygiene dispenser is in use in the housing, andconfiguring each hand hygiene dispenser to communicate via a low energytransmission protocol. The method can also include configuring thecontainer to be squeezed to dispense sanitizer and to actuate the inputwithin the housing, providing the container with a wall, the wall beingplaced adjacent the input such that the wall contacts the input andactuates the input when the user dispenses the hand sanitizer storedwithin the container, providing each of the hand hygiene dispensers witha display for displaying hand hygiene data, and configuring the lowenergy transmission protocol as low energy Bluetooth.

The example method may also include one or more of: providing aplurality of computing devices, configuring each computing device toreceive data from the plurality of hand hygiene dispensers regardingwhen one or more hand sanitizing events have occurred via the low energytransmission protocol, configuring each of the hand hygiene dispensersto send the hand sanitizing events stored on the memory to one of thecomputing devices when the hand hygiene dispensers are within apredetermined range of the one of the computing devices.

The method can also include configuring a calculation module todetermine by a processor a dispensing rate of one or more of theplurality of hand hygiene dispensers for one or more predetermined timeperiods, calculating an average dispensing rate based on a predeterminednumber of dispensing rates, to send a notification to an individual userregarding the individual user's hand hygiene performance, to identifyeach of the plurality of the hand hygiene dispensers with an individualuser. The method may also include placing the calculation module on theplurality of hand hygiene dispensers, on the plurality of computingdevices, or at a remote location. The method can also include using themotion information to identify motion and hand hygiene patterns, andusing the motion and hand hygiene patterns to create templates forevaluating hand hygiene data.

Aspects of the disclosure may be provided in a computer-readable mediumhaving computer-executable instructions to perform one or more of theprocess steps described herein.

Aspects of the disclosure have been described in terms of illustrativeembodiments thereof. Numerous other embodiments, modifications andvariations within the scope and spirit of the disclosure will occur topersons of ordinary skill in the art from a review of this entiredisclosure. For example, one of ordinary skill in the art willappreciate that the steps illustrated in the illustrative figures may beperformed in other than the recited order, and that one or more stepsillustrated may be optional in accordance with aspects of thedisclosure.

1. A system comprising: a hand hygiene dispenser comprising a housing comprising an input for detecting hand sanitizing events when hand sanitizer is dispensed from a container, and a memory for storing the hand sanitizing events; a computing device configured to receive data from the hand hygiene dispenser regarding when one or more hand sanitizing events have occurred; and a calculation module configured to detect whether a predetermined amount of hand sanitizing solution is used, wherein detecting whether the predetermined amount of hand sanitizing solution is used comprises: detecting a number of dispenser activations; measuring, by a sensor in communication with the calculation module, an amount of hand sanitizing solution within the container; and comparing the number of dispenser activations with the measured amount of hand sanitizing solution in the container.
 2. The system of claim 1, wherein the calculation module is configured to send a notification regarding an individual user's hand hygiene performance to the hand hygiene dispenser for displaying the notification.
 3. The system of claim 1, wherein the calculation module is located at the hand hygiene dispenser, the computing device, or a remote location.
 4. The system of claim 1, wherein the calculation module is configured to review the dispensing of the hand hygiene dispenser over a predetermined time period to determine whether the hand hygiene dispenser has a higher dispensing rate to detect cheating by a user.
 5. The system of claim 1, wherein the container is configured to be squeezed to dispense sanitizer and to actuate the input within the housing.
 6. The system of claim 5, wherein the container defines a wall, the wall being placed adjacent to the input such that the wall contacts the input and actuates the input when a user dispenses the hand sanitizer stored within the container.
 7. The system of claim 1, wherein the hand hygiene dispenser include a display for displaying hand hygiene data.
 8. The system of claim 1, wherein the hand hygiene dispenser is configured to communicate to a network via a low energy transmission protocol.
 9. The system of claim 8, wherein the low energy transmission protocol is low energy Bluetooth.
 10. The system of claim 1, wherein each of the hand hygiene dispenser are configured to send the hand sanitizing events stored on the memory to one of the computing device when the hand hygiene dispenser are within a predetermined range of the one of the computing device.
 11. The system of claim 1, wherein a processor is configured to provide an electronic certification based on a minimum number of shifts by a user and a ratio of shift use rates at or above a predetermined goal rate.
 12. A method comprising: providing a hand hygiene dispenser including a housing configured to receive a container configured to contain hand sanitizer, providing the housing with an input for detecting hand sanitizing events when the hand sanitizer is dispensed from the container, and providing a memory for storing the hand sanitizing events; providing a computing device configured to receive data from the hand hygiene dispenser regarding when one or more hand sanitizing events have occurred; and configuring a calculation module to detect whether a predetermined amount of hand sanitizing solution is used, wherein configuring the calculation module to detect whether the predetermined amount of hand sanitizing solution is used comprises: detecting a number of dispenser activations; measuring, by a sensor in communication with the calculation module, an amount of hand sanitizing solution within the container; and comparing the number of dispenser activations with the measured amount of hand sanitizing solution in the container.
 13. The method of claim 12, further comprising configuring the calculation module to send a notification to an individual user regarding a hand hygiene performance of the individual user.
 14. The method of claim 12, further comprising placing the calculation module at the hand hygiene dispenser, the computing device, or a remote location.
 15. The method of claim 12, further comprising configuring the container to be squeezed to dispense sanitizer and to actuate the input within the housing.
 16. The method of claim 15, further comprising providing the container with a wall, the wall being placed adjacent the input such that the wall contacts the input and actuates the input when a user dispenses the hand sanitizer stored within the container.
 17. The method of claim 12, further comprising providing each of the hand hygiene dispenser with a display for displaying hand hygiene data.
 18. The method of claim 12, further comprising configuring each of the hand hygiene dispenser to send the hand sanitizing events stored on the memory to one of the computing device when the hand hygiene dispenser are within a predetermined range of the one of the computing device.
 19. The method of claim 12, further comprising providing an electronic certification based on a minimum number of shifts by a user and a ratio of shift use rates at or above a predetermined goal rate.
 20. The method of claim 12, wherein the hand hygiene dispenser is configured to communicate to a network via a low energy transmission protocol. 